Provider Demographics
NPI:1073512372
Name:BOTSFORD KIDNEY CENTER
Entity Type:Organization
Organization Name:BOTSFORD KIDNEY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SIDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:BASKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-442-7901
Mailing Address - Street 1:28425 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-2008
Mailing Address - Country:US
Mailing Address - Phone:248-442-7901
Mailing Address - Fax:248-442-2041
Practice Address - Street 1:28425 8 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-2008
Practice Address - Country:US
Practice Address - Phone:248-442-7901
Practice Address - Fax:248-442-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-19
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2791559Medicaid
232518Medicare ID - Type Unspecified